The Role of Endoscopy in the Diagnosis and Management of Upper Gastrointestinal Bleeding.

Background: Upper gastrointestinal bleeding is a common medical and surgical emergency. The aim of the study is to comprehend the aetiology of upper gastrointestinal bleeding by endoscopy and to evaluate the different endoscopic modalities for the management of upper gastrointestinal bleed. Methods: In 117 haemo-dynamically stable patients with the history of upper gastro-intestinal bleed endoscopy was done and possible site and cause of bleeding determined .The bleeding was stopped using one or more of the undermentioned modalities- Endoscopic Sclerotherapy (ES) using absolute alcohol, Endoscopic Varicael ligation (EVL), Injection Epinephrine (1:100,000) Results: Out of 84 patients bleeding was stopped in 81(96.42%) by endoscopic intervention. Among 72 (85.71%) patients of oesophageal varices treated with ES, re-bleed occurred in 2 (2.38%) patients. While out of 12 (14.28%) non variceal patients, rebleed occurred in 1 (8.30%) patient. Conclusion: Most of the upper gastrointestinal bleed patients who presented in our setup were having varices. On the basis of lower rates of re-bleeding, mortality, complications and need for fewer endoscopic treatments, ligation should be considered as the endoscopic treatment of choice for patients with oesophageal variceal bleeding.

New Classification of Bile Duct Injuries Based on Clinical Scenarios.

A new classification of the iatrogenic bile duct injuries based on clinical scenario is presented. It is actually clinical scenario which determines the type and time of intervention required. From the initial classification published by Bismuth, there have been many classifications of common bile duct injury. The article reviews the various classification systems.

Comparison of ramosetron and ondansetron for control of post-operative nausea and vomiting following laparoscopic cholecystectomy.

Background: Post-operative nausea and vomiting (PONV) is common. 5HT 3 receptor antagonists are commonly used drugs for its prevention. A study was designed to compare the efficacy and safety of ramosetron and ondansetron in patients undergoing laparoscopic cholecystectomy (lap chole). Materials and Methods: A prospective randomized case controlled study was conducted at J. N. Medical College Hospital, Aligarh Muslim University, Aligarh, India, in patients who underwent lap chole following intravenous administration of ondansetron (4mg) or ramosetron (0.3mg) at the end of surgery, and efficacy as well as side effects of ondansetron and ramosetron was documented and compared. Results: One hundred and thirty adult females undergoing lap chole were studied - 65 patients in each of the two groups. In first 24 h after surgery, complete response (No PONV) was observed in 28 patients of the ondansetron group and in 32 patients of the ramosetron group (P>0.05). Complete response in the second 24 h after surgery was observed in 30 patients of the ondansetron group and in 45 patients of the ramosetron group (P<0.05). During the first and second 24 h, PONV requiring rescue antiemetic was significantly higher (P<0.05) in the ondansetron group as compared to the ramosetron group. Adverse drug effects in the post-operative period were observed in 11 and 8 patients in ondansetron and ramosetron groups respectively (P>0.05). Conclusion: Ramosetron was found safe and more effective antiemetic than ondansetron in patients undergoing lap chole.